Prognostic Impact of High-Molecular-Weight von Willebrand Factor Multimer Ratio in Classical Low-Flow Low-Gradient Aortic Stenosis
Sprache des Titels:
Englisch
Original Kurzfassung:
High-molecular-weight (HMW) von Willebrand
factor (VWF) multimer deficiency occurs in classical low-flow,
low-gradient (LF/LG) aortic stenosis (AS) due to shear force
induced proteolysis. The prognostic value of HMW VWF mul
timer deficiency is unknown. Therefore, we sought to evaluate
the impact of HMW VWF multimer deficiency on clinical out
come. Methods: In this prospective research study, a total of 83
patients with classical LF/LG AS were included. All patients
underwent dobutamine stress echocardiography to distinguish
true-severe (TS) from pseudo-severe (PS) classical LF/LG AS.
HMW VWF multimer ratio was calculated using densitometric
Western blot band quantification. The primary endpoint was all
cause mortality. Results: Mean age was 79 ± 9 years, and TS
classical LF/LG AS was diagnosed in 73% (n=61)andPSclassical
LF/LG AS in 27% (n = 22) of all patients. Forty-six patients
underwent aortic valve replacement (AVR) and 37 were treated
Received: November 22, 2023
Accepted: May 22, 2024
Published online: June 24, 2024
conservatively.Duringameanfollow-upof27±17months,47
deaths occurred. Major bleeding complications after AVR (10/46;
22%) were more commonin patients with HMW VWF multimer
ratio <1 (8/17; 47%) in comparison to patients with a normal
multimer pattern (2/29; 7%) at baseline (p = 0.003). In a mul
tivariable Cox regression analysis, HMW VWF multimer defi
ciency was a predictor of all-cause mortality (HR: 3.02 [95% CI:
1.31?6.96], p = 0.009) in the entire cohort. This association was
driven by higher mortality rates in the AVR group (multivariable
adjusted HR: 9.4; 95% CI 2.0?43.4, p= 0.004). Conclusions: This is
the first study to demonstrate the predictive value of HMW VWF
multimer ratio for risk stratification in patients with classical LF/
LG AS. HMW VWF multimer deficiency was associated with an
increased risk of all-cause mortality and major bleeding com
plications after AVR
Forschungs-